Full text

The COVID-19 pandemic has impacted the lives of very many people in different ways around the world. The impact of the pandemic on delaying cancer diagnosis and subsequent treatment has been well-documented but the pandemic has also had significant consequences for many other patient groups experiencing a wide variety of life-changing and potentially life-ending conditions. In this editorial, the focus will be on the pandemic's impact on individuals experiencing Eating Disorders and Other Specified Feeding or Eating Disorders (OSFED). This is an important issue for all nurses because eating disorders are currently the leading cause of death amongst individuals experiencing mental ill-health.

An eating disorder is a diagnosable mental illness characterised by an obsession with food, either eating too little or too much. Individuals experiencing an eating disorder often use food as a response to intrusive thoughts, which might be around size and shape of food or could be about fear of some types of food, such as carbohydrates or fats. Some individuals might even experience hallucinations and reduced cognitive function related to their eating disorder. OSFED sits on a spectrum somewhere between ‘normal eating’ and an ‘eating disorder’ and can be characterised by behaviours such as restrictive eating, binge eating, skipping meals, avoiding food groups, use of diet pills or laxatives and self-induced vomiting. The consequences of OSFED eating can be as serious as eating disorders. Eating disorders and OSFED can lead to serious and life-threatening physical and psychological side effects and, in a significant number of cases, to death.

During and after the COVID-19 pandemic, the prevalence of eating disorders and OSFED eating have grown substantially. This has resulted in increasing demands on many health services in mental health care, primary health care and in general hospital services. Perhaps the biggest challenge is outside mental health where there might already be a significant lack of focus on mental health or where there might be a lack of knowledge and experience around the presentation and management of eating disorders, or the communication skills required to support individuals presenting with eating disorders. Emergency departments, acute medical wards and paediatric wards are examples of extremely busy clinical areas where the multiple demands on nurses, lack of knowledge and experience of caring for people with eating disorders and lack of resources can increase the demands placed in nurses and can result in inadequate care for individuals seeking support for eating disorders (Rodgers et al., 2020).

There needs to be a shift in thinking about how individuals presenting with eating disorders are supported in hospital settings. It is important that all nurses have an understanding of eating disorders, so they are able to provide appropriate care and support to the growing number of individuals requiring this support, wherever it is needed.

The nursing care provided for individuals with eating disorders is highly specialised and draws on unique knowledge and understanding. Individuals with eating disorders might need to have their food intake carefully monitored, which can create challenges if they are being cared for in the wrong environment or are being cared for by nurses who lack the necessary knowledge and experience. Individuals with eating disorders may also undertake compensatory behaviours, such as over-exercising, purging or using laxatives, if they feel guilty about the food they have consumed. Again, ensuring adequate and accurate monitoring can be challenging.

Nurses familiar with caring for individuals with eating disorders will be aware of the need to maintain clear and consistent boundaries. Establishing and maintaining these boundaries can be difficult in acute care settings. Clear communication between all those involved in providing care for people with eating disorders, including their families, can also be challenging in the wrong clinical area or where those providing support lack knowledge and experience.

Nurses unfamiliar with caring for individuals with eating disorders might unintentionally use inappropriate terminology, such as ‘you are looking healthier’, which can have a detrimental impact on future behaviour (Beat Eating Disorders, 2022). It is important to remember that individuals who are recovering from an eating disorder are continuously battling intrusive thoughts about their intake, body image and self-esteem. A one seemingly positive comment from a healthcare practitioner can have negative implications for the individual involved.

Without knowledgeable and experienced support in an appropriate clinical environment, efforts to support individuals with eating disorders may not be as effective as they might otherwise be. The consequences of inadequate support can be devastating, including serious mental and physical health complications and even death. It is important, therefore, that all nurses, regardless of area of practice, acquire some knowledge and understanding of eating disorders and OSFED. This could be achieved through e-learning, in-house training and annual updates. Nurses will already be familiar with multiple annual training activities but, with the possible exception of resuscitation training, it is unlikely that any other annual training might have a positive impact on so many lives. As the number of individuals needing this support increases, so does the imperative to ensure that nurses everywhere have the knowledge and skills required.

The COVID-19 pandemic had an immense impact on all aspects of everyday life with many people having to drastically change their usual daily routines. The impact of making such changes to everyday life was felt not only by those with existing mental health illnesses but also by those without existing mental health challenges, many of whom adopted maladaptive coping mechanisms around eating in an attempt to retain a sense of control.

Throughout the United Kingdom (UK) those most affected were children, young people, those already experiencing emotional dysregulation and those with a known eating disorder. These individuals appear to have been most affected because of the high levels of stress and uncertainty caused by the pandemic and limitations imposed on them (Sideli et al., 2021). One of the most important limitations faced by children and young people was the immediate shift to online learning in schools, colleges and universities. Overnight, many children and young people were deprived of important support networks and contact with friends. This impact has also been seen in similar groups around the world but most obviously in higher income countries.

As health services around the world responded to new and significant challenges in delivering healthcare, many hospital appointments were cancelled or moved online. For some, this meant that opportunities for early intervention were missed and for others ongoing support was restricted and less effective. In the UK, referrals have increased as COVID-19 restrictions were lifted, with 10,000 children and young people starting interventions for eating disorders between April and December 2021 (Solmi et al., 2021). This is an increase of two-thirds since COVID-19 restrictions were in place.

A further complication is that many eating disorders and OSFED service users, including children, young people and adults, are being managed in physical health teams and settings. This is not the right environment because there is a danger that a lack of experienced mental health input could result in a further decline in an individual's mental health. As part of the NHS Implementation Plan in the UK, there will be an opportunity to review the current provision of mental health care outside mental health care settings and how such services are resourced (National Health Service, 2019). People needing support and intervention for eating disorders need specialised support from knowledgeable practitioners that might not always be available in general hospital settings.

The COVID-19 pandemic has resulted in an increase in eating disorders and OSFED around the world. As a consequence, there has also been an increase in critical and life-threatening illnesses in people with eating disorders in different clinical settings. It is, therefore, important that all nurses have an understanding of eating disorders, so they can provide the best care possible in any healthcare setting.

全文翻譯（僅供參考）

新冠肺炎大流行以不同方式影響了世界各地許多人的生活。大流行對延遲癌癥診斷和后續(xù)治療的影響已得到充分記錄，但大流行也對許多其他患者群體產生了重大影響，這些患者群體經歷了各種各樣的改變生命和可能導致生命終結的疾病。在這篇社論中，重點將是大流行對飲食失調和其他特定飲食或飲食失調（OSFED）患者的影響。這對所有護士來說都是一個重要的問題，因為飲食失調目前是精神病患者死亡的主要原因。

飲食失調是一種可診斷的精神疾病，其特征是對食物的癡迷，要么吃得太少，要么吃太多?；加酗嬍痴系K的人通常會用食物作為對侵入性想法的回應，這些想法可能與食物的大小和形狀有關，也可能與對某些類型食物的恐懼有關，例如碳水化合物或脂肪。有些人甚至可能會出現(xiàn)幻覺和與飲食失調相關的認知功能下降。OSFED介于“正常飲食”和“飲食失調”之間，其特征可能是限制性飲食、暴飲暴食、不吃飯、避開食物組、使用減肥藥或瀉藥以及自我誘導嘔吐等行為。OSFED飲食的后果可能與飲食失調一樣嚴重。飲食失調和OSFED會導致嚴重的、危及生命的身體和心理副作用，在很多情況下，還會導致死亡。

在新冠肺炎大流行期間和之后，飲食障礙和OSFED飲食的流行率大幅上升。這導致對精神衛(wèi)生保健、初級衛(wèi)生保健和綜合醫(yī)院服務中許多保健服務的需求增加。也許最大的挑戰(zhàn)是在心理健康之外，可能已經嚴重缺乏對心理健康的關注，或者可能缺乏關于飲食失調的表現(xiàn)和管理的知識和經驗，或者缺乏支持飲食失調患者所需的溝通技能。急診室、急癥病房和兒科病房是非常繁忙的臨床區(qū)域的例子，在這些區(qū)域，對護士的多重需求、缺乏照顧飲食失調患者的知識和經驗以及缺乏資源可能會增加對護士的需求，并可能導致對尋求飲食失調支持的個人的護理不足（Rodgers等人，2020年）。

對于在醫(yī)院環(huán)境中如何支持患有飲食障礙的個人，需要改變想法。重要的是，所有護士都要了解飲食失調，以便能夠在需要時為越來越多需要這種支持的人提供適當?shù)淖o理和支持。

為飲食失調患者提供的護理是高度專業(yè)化的，并利用獨特的知識和理解?；加酗嬍痴系K的個人可能需要對其食物攝入進行仔細監(jiān)測，如果他們在錯誤的環(huán)境中被照顧，或者由缺乏必要知識和經驗的護士照顧，這可能會帶來挑戰(zhàn)?；加酗嬍痴系K的人如果對自己吃的食物感到內疚，也可能會采取補償行為，如過度鍛煉、清洗或使用瀉藥。同樣，確保充分和準確的監(jiān)測可能具有挑戰(zhàn)性。

熟悉照顧飲食失調患者的護士將意識到需要保持清晰一致的界限。在急性護理環(huán)境中，建立和維持這些界限可能很困難。在錯誤的臨床領域或提供支持的人員缺乏知識和經驗的情況下，所有參與為飲食失調患者提供護理的人員（包括他們的家人）之間的清晰溝通也可能具有挑戰(zhàn)性。

不熟悉照顧飲食失調患者的護士可能會無意中使用不恰當?shù)男g語，例如“你看起來更健康”，這可能會對未來的行為產生不利影響（Beat eating disorders，2022）。重要的是要記住，那些正在從飲食失調中恢復的人，正在不斷地與關于他們的攝入量、身體形象和自尊的侵擾性思想作斗爭。醫(yī)療從業(yè)者的一個看似正面的評論可能會對相關個人產生負面影響。

如果在適當?shù)呐R床環(huán)境中沒有知識和經驗豐富的支持，支持進食障礙患者的努力可能不會像其他情況那樣有效。支持不足的后果可能是毀滅性的，包括嚴重的心理和身體健康并發(fā)癥，甚至死亡。因此，重要的是，所有護士，無論執(zhí)業(yè)領域如何，都要對飲食失調和OSFED有一定的了解和了解。這可以通過電子學習、內部培訓和年度更新來實現(xiàn)。護士們已經熟悉多個年度培訓活動，但除了復蘇培訓之外，其他年度培訓不太可能對這么多人的生活產生積極影響。隨著需要這種支持的人數(shù)增加，確保各地護士具備所需知識和技能的必要性也隨之增加。

新冠肺炎大流行對日常生活的各個方面都產生了巨大影響，許多人不得不徹底改變他們的日常生活。對日常生活做出這種改變的影響不僅存在于患有心理健康疾病的人身上，也存在于那些沒有心理健康挑戰(zhàn)的人身，他們中的許多人在飲食方面采取了不適應的應對機制，試圖保持控制感。

在整個英國（UK），受影響最大的是兒童、年輕人、已經經歷情緒失調的人和已知飲食失調的人。這些人似乎受到了最嚴重的影響，因為大流行和對他們施加的限制造成了高度的壓力和不確定性（Sideli等人，2021）。兒童和年輕人面臨的最重要的限制之一是學校、學院和大學立即轉向在線學習。一夜之間，許多兒童和年輕人被剝奪了重要的支持網絡和與朋友的聯(lián)系。這種影響也見于世界各地的類似群體，但最明顯的是高收入國家。

隨著世界各地的醫(yī)療服務部門在提供醫(yī)療服務方面應對新的重大挑戰(zhàn)，許多醫(yī)院預約被取消或在線轉移。對一些人來說，這意味著錯過了早期干預的機會，而對其他人來說，持續(xù)的支持受到限制，效果較差。在英國，隨著新冠肺炎限制的解除，轉診人數(shù)增加，2021 4月至12月期間，有10000名兒童和年輕人開始對飲食障礙進行干預（Solmi等人，2021）。自新冠肺炎限制實施以來，這一數(shù)字增加了三分之二。

更復雜的是，許多飲食失調和OSFED服務用戶，包括兒童、年輕人和成年人，都在身體健康團隊和環(huán)境中進行管理。這不是一個合適的環(huán)境，因為缺乏經驗豐富的心理健康投入可能會導致個人心理健康進一步下降。作為英國NHS實施計劃的一部分，將有機會審查目前在心理健康護理機構之外提供的心理健康護理，以及這些服務的資源配置情況（國家健康服務局，2019年）。需要飲食失調支持和干預的人需要來自知識淵博的從業(yè)者的專業(yè)支持，而在普通醫(yī)院環(huán)境中，這可能并不總是可用的。

新冠肺炎大流行導致全世界飲食失調和OSFED的增加。因此，在不同的臨床環(huán)境中，患有飲食障礙的人中，危重和危及生命的疾病也有所增加。因此，重要的是，所有護士都要了解飲食失調，這樣他們才能在任何醫(yī)療環(huán)境中提供最好的護理。

THE

END

本文由“健康號”用戶上傳、授權發(fā)布，以上內容（含文字、圖片、視頻）不代表健康界立場?！敖】堤枴毕敌畔l(fā)布平臺，僅提供信息存儲服務，如有轉載、侵權等任何問題，請聯(lián)系健康界（jkh@hmkx.cn）處理。

相關知識

創(chuàng)傷后應激障礙的護理
孕期睡眠障礙的流行病學研究進展
心智障礙者監(jiān)護之困：特殊家庭正在遭遇沉重挑戰(zhàn)
一文了解創(chuàng)傷和創(chuàng)傷后應激障礙流行病學特征
進食障礙：一種心理疾病的“性別色彩”
什么是情緒調節(jié)障礙？如何應對情緒調節(jié)障礙？
重塑味覺之旅：吞咽障礙患者的科學進食指南
創(chuàng)傷后應激障礙能治愈嗎 創(chuàng)傷后應激障礙可以治好嗎
減肥要適度！別讓進食障礙找上門
創(chuàng)傷后應激障礙是怎么造成的

網址: 進食障礙和其他特定的喂養(yǎng)或進食障礙：對所有護士的大流行后挑戰(zhàn) http://m.u1s5d6.cn/newsview171758.html